Ruminations by a non-academic general surgeon from the heart of the rust belt.

Saturday, November 15, 2008

Fly away surgery

I like this idea. It's certain to catch on. Apparently workers for the Wisconsin company Serigraph can have their copays and coinsurance waived for certain elective operations. All they have to do to qualify is hop on a plane and fly half way around the world to a "fancy tourist hospital" in India for the surgery. Now that sounds awesome. I can't think of a better way to recover from a hernia repair or a knee replacement than to fly coach on Continental for 14 hours.

And what about the part-time workers and the new guys with half benefits? What happens if they need a lap chole? Do they also get the tourist hospital treatment? Or do they have to settle for a voyage across the Atlantic on a wooden raft to Bangladesh for bare bones surgery at some open air tent-hospital in the jungle where they give you a piece of bamboo to bite down on instead of anesthetic?

Now I'm all for globalism but there's a point when too much of anything starts to tip matters into the realm of the absurd. What we see here is yet another bad consequence of the forced coupling of health insurance to employment.

Your issue, je pense, it is clearly with the health insurance company and, as you state, its "forced coupling" to employment. So why muddy the water, as they say, by casting the aspersions on health care outside of the United States? You don't strike La Belle et Bonne Bianca Castafiore as a xenophobe -- far from it.

It's tempting to make India (or Bangladesh, or X) the symbolic emblem of your displeasure -- and see how quickly one of your readers has latched on to that as your intent?

Bianca-Surely you'll agree that there are places on earth where the provision of health care is substandard. That's a fact, no? Not xenophobic. If corporations and health insurance titans have a financial stake/responsibility for providing health care for employees, of course they will explore all options to make he bottom line look better. It doesn't have to be Bangladesh and it doesn't have to necessary imply a lesser quality of care. What if a company in El Paso set up a deal with some clinic across the border in Mexico. And all employees had to see mexican physicians for primary care needs? Not out of the realm of possibility. The care would likely be just as good but you have to wonder about the soundness of such an ostensibly bountiful country that now seeks to outsource fundamental provisions like health care to its citizens...

Actually, I think we ought to have a cup of coffee down at the coop, coffee brewed from the fair trade beans we will have roasted ourselves... I am partial to a slightly charred taste, moi-même!

Of course I agree that substandard care exists -- in every country -- and in a few, "substandard" barely begins to be an appropriate description.

You were not charged as being a xenophobe, so calmez-vous. No, you simply gave several clever nods in that direction, beginning with the visual (ye olde img_394635_t!) and continuing with the subtle jibes about rafts and bamboo. Certes, you are also not responsible for the commentary you receive, though I contend that the tail end of your post might become a comfortable Rest Stop for chauvinists.

"The care would likely be just as good but you have to wonder about the soundness of such an ostensibly bountiful* country that now seeks to outsource fundamental provisions like health care to its citizens..." Hmm. Are the health insurance companies and the employers that served as counterpoint in the body of your initial post now morphed into the monolithic subject known as "country"? Do you posit an equivalency between "country" and "government"? I hope so, because I also think that health care is a provision that is fundamental to its citizenry. (In short, we are in agreement, as scary as that might be!)

And now... I go in search of an actual cup of coffee. Thank you for the dialogue and for this venue.

*The bountiful nature of the United States is in doubt here at Marlinspike Hall, Tête de Hergé, given the downward spike of our investment account totals! Of course, it is quite the contrarian stance for a Socialist to dabble in the stock market...

Many US citizens already flock to Canada for prescription drugs and Mexico (and even Cuba) for dental care or minor surgeries. Thailand, Singapore, China, Taiwan and even Russia are other medical tourism destinations for anything from total hip replacement to LASIK. Many of the oversea surgeons are Ivy League trained and use state-of-the-art equipment imported right from the States. Post-operative care and followup would sometimes post a challenge, though.

It all depends on the type and extend of the disease process (i.e. pathology) involved and its potential to cause greater harm (e.g. disability or worse) in near or far future. It helps to consult your primary care physician for a comprehensive assessment first before deciding whether surgery or other means of management/treatment is necessary.

type of medical tourism. old people from all over the world come to visit our great kruger park. because they are old, they get age related sicknesses and we end up treating them. whenever i get one, i really feel sorry for them. necrotic bowel can really mess up an otherwise great game drive.

Insurance companies (and other private interest groups) have made health care in US very much like a market place. Medical tourism gives cost-conscious patients a financial incentive to seek treatment abroad (most of which are self-financed, by the way), "OFF RECORD," in addition to a coincidental opportunity to vacation abroad.

Between "loyalty" and a cost-effective mean to get well, i'd choose the later every time.

I've heard of recent cases 'medical tourism' over here in sunny old England. It happens because our NHS waiting lists are so long. It's mainly people wanting hip replacements or dental treatment. In some cases it's worked well (patients going to France, for example). But questions arise as to aftercare and proper follow-up? And what if there are complications?

I can understand your concerns - employees shouldn't be forced to travel overseas. But remember, these are elective surgeries and employers have to pay for higher costs from the same profits. The only market way of dealing with this is to reduce profits for all.

On the other hand, hospitals are not that bad in India. Some are even better than those in the U.S. It's time to check from patients who have travelled. (http://flyforsurgery.biz/testimonials/)

But overall, hope for America's healthcare revival. Until then, face the grime reality and be thankful for the India option.

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